Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice

Abstract

A positive cumulative fluid balance is associated with IAH and worse outcomes. Interventions to limit the development of a positive cumulative fluid balance are associated with improved outcomes. In patients not transgressing spontaneously from the Ebb to Flow phases of shock, late conservative fluid management and late goal directed fluid removal (de-resuscitation) should be considered.

Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis

“…This is in contrast to a previous meta-analysis [6], and likely reflects our exclusion of observational data from our meta-analysis. We found that a conservative or deresuscitative fluid strategy resulted in a greater number of VFDs and decreased length of ICU stay than a liberal fluid strategy or standard care, with no increase in acute kidney injury, use of RRT, or cognitive dysfunction.…”

“…A previous systematic review and meta-analysis on the topic of fluid overload and the relationship between fluid balance and mortality [6] in critically ill patients reported studies with considerable heterogeneity in design, presence of comparator groups, populations, as well as the timing and nature of interventions. By narrowing our focus to specific populations, and by including but not attempting to meta-analyse observational studies, we aimed to maximise both the external and internal validity of our review.…”

It is time to consider the four D’s of fluid management

“…The EALC and ECLC groups carry the best prognosis [25]. Now we have listed some basic definitions on fluids we will elaborate further on fluids as drugs.…”

“…However, although many clinicians use certain triggers to start, they are not aware of the triggers to stop fluid resuscitation, hence carrying the potential of fluid overload with deleterious effects on patient morbidity and mortality [25].…”

Management of Abdominal Compartment Syndrome in Acute Pancreatitis

“…The ileus that often accompanies this disease process as well as the development of ascites may further increase the intra-abdominal volume but a major contributor is undoubtedly the fluid resuscitation that is often initiated in patients with severe pancreatitis to compensate for central hypovolemia due to third spacing. Early aggressive fluid resuscitation is still considered the standard of care in many guidelines; however, fluid overload (although variably defined) has been found to be a major risk factor in several studies and different patient categories (23). Also in studies that specifically looked into ACS in pancreatitis, fluid resuscitation was consistently reported as contributing to both increased intraabdominal volume and reduced abdominal wall compliance (6).…”